Nikki Greenaway (00:03): Sometimes the providers back in the hospital, like, “She needs to come here. I can only provide care here.” No, we need to learn how to provide better community care.
And that’s what our practice really challenges our healthcare system to do, is to provide better community care, because not everyone can access that tertiary care center or whatever. They can’t always come back to there. That cannot be the only safe space. We have to learn how to provide care in the community.
Nacole Riccaboni (00:27): That’s Nikki Greenaway, a family nurse practitioner with a truly unique community-based approach to women’s health. If you tuned in last season, you remember my conversations with Nikki about how to navigate and nurse relationships and be the change you want to see in health care. If you missed those episodes, definitely, definitely go back and listen. They’re some of my favorite ones.
This time around, we talk about the deep, deep black maternal health disparities in this country and what Nikki’s doing to address them in New Orleans. All of her patients are young black and brown mothers, with many experiencing homelessness, sexual and physical abuse, as well as poverty.
Nikki is working hard to remove the barriers that these women face. From education on Instagram, to home visits, to personalized care packages, this medical MacGyver is finding all kinds of creative ways to help her patients thrive.
My name is Nacole Riccaboni, and I’m a critical care nurse working in Florida and your host for SHIFT Talk season two, guys. SHIFT Talk is a podcast that brings nurses together to talk about the challenges we’re facing both on and off the clock. This season, we’re interviewing nurses who are working to ensure that all patients can get the resources and care they need in order to be healthy. That’s called health equity, by the way.
We’re going beyond the clinical and looking at the social factors that impact health, from a person’s zip code to their education, to their job — even structural racism. We all know so much about patients’ lives, right? So we can really, really make an impact for folks.
This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers. SHIFT is sponsored by the Robert Wood Johnson Foundation.
Follow us on Instagram @shiftnursing, and for more amazing stories and real talk about nursing, head over to shiftnursing.com. One final note: This episode was recorded in June, so please keep that in mind as you listen to this amazing conversation. Now let’s dig in.
Nikki, welcome back to shift talk. Can you share a little bit about your background and the work that you do today to our listeners?
Nikki (02:52): Yes, thank you for having me. I am a family nurse practitioner that specializes in women’s health, or what I like to call postpartum primary care. I came up with that name on my own. I am also an international board certified lactation consultant. I have a private practice called Bloom Maternal Health, and we are based in New Orleans, Louisiana.
Nacole (03:15): You’re wearing a lot of hats. You’re doing a lot of things. Very nice.
Nikki (03:19): As folks say, I’m doing the most.
Nacole (03:21): Hey, that’s always good. Your community needs you. Now, speaking of doing the most, what inspired you to move from working in the hospital setting to starting your own practice?
Nikki (03:31): So, let’s think about when we finish nursing school, we’re always told to be a floor nurse, to get that foundation experience, get in there, get all the stuff you need and then you can branch out from there.
Nobody tells you to dive right into community nursing. However, when you finish NP school, they’re like, “Just go be a NP.” And I didn’t really know what that meant. So when I finished NP school, I had a different, probably, change of events than most people. I was eight months pregnant.
And then once I had my son, and he was four months old, I was like, “Okay, now I’m ready to dive in this NP. This is what I’ve built up my career for. This is what I went to school for.” But all of that, kind of the events of graduation, I had just moved into a new house, had a baby, all of that started to take a mental toll on me and just being a parent.
Because I’m a pediatric nurse by trade. I’ve taken care of babies my whole career. And then I have this baby on my own. And I’m like, “When is my shift over?”
Nacole (04:29): Says every mom.
Nikki (04:31): I’m coming in too real. Right. Who’s coming in to relieve me? I just really felt stuck. So I confided in my brother. He’s a pastoral counselor, and he really helped me navigate my feelings.
And he said, “You actually find so much joy in your work that that is the missing piece. You need to go back to work. As much as you’re trying to be a stay at home mom, maybe that’s just not your jam. That’s not your lane, sis. That’s not your ministry.”
It’s not what I’m here for. And not to knock anyone that does it, but it just wasn’t working for me, especially because I had built — there was so much momentum up to this point and then it just stopped. And then I was a mom, and I’m like, “Wait, I didn’t actually prepare for this. I prepared for the NP thing.”
So, he’s like, “Be the change you want to see. Go out there and help moms navigate this weird space that they’re in.” Because I felt like somebody should have been helping me navigate. I shouldn’t have to call my brother who doesn’t really know anything about postpartum or anything like that. But he knew that I was stuck and that I needed to get back to things that I loved.
And I love working with babies. And I was like, “But what about the mom?” It’s not the baby that’s struggling. My son is fine. It’s me. Babies are healthy. Moms are healing. I am the one that needs to help you say, “Well, go out there and be the change you want to see and be nurse Nikki to those moms.” And that’s where my practice started 10 years ago.
Nacole (05:51): That’s so good to hear, because I felt the same way. Like you said, the baby’s fine. I’m glad he’s gaining weight. I’m glad he’s eating. What about me, though? Could somebody circle back to me?
Nikki (06:02): And you’re starving. The baby’s healthy, exactly what you said. The baby’s healthy, gaining weight, but the mother is starving.
Nacole (06:06): Yes.
Nikki (06:07): Mentally and physically.
Nacole (06:09): Well said, because once you have the kid, everyone’s all over the kid, like, “Oh my God, I want to hold the baby.” And I guess they forget that you have gone through something also.
Nikki (06:18): Right. Right. My friend, who’s a therapist, she said, “Everybody wants to hold the baby. Who’s going to hold the mother?”
Nacole (06:23): I know. That’s so true. Now, was it a particular moment that you spoke to your brother that was your kind of aha moment that you’re going to have the courage to do this? Or was it over a series of conversations?
Nikki (06:34): I think it was over a series of conversations, but after talking to my husband, because I don’t really think — he’s seen me in this like strong personality, strong emotions, but always able to overcome.
And he couldn’t figure out, “Why can’t you overcome this? Why aren’t you getting over this?” And even my own family, they’re like, “You’re such a peaceful person and high energy.” And like, “Why are you so low energy?” And it felt really selfish, but I’m like, “I don’t have anything to give y’all, because I don’t have anything to give myself.”
And that is the scary part of postpartum depression. And a lot of people think it’s such a selfish thing. “Why were you being so selfish?” No, I don’t want to be a burden, so I want to take myself out of this equation. And so you’ll probably be happier if my sadness is not looming like a cloud over this family.
Nacole (07:22): Now, Nikki, can you talk about the state of black maternal health in this country and really kind of what’s behind some of the dire statistics that we’re seeing in the news?
Nikki (07:31): So, black women are 4 to 12 times — 12 times — more likely to experience maternal morbidity or mortality than white women of equal or lesser education or socioeconomic status.
So, it doesn’t even matter if you have a college degree, it doesn’t matter if you don’t have a — there are black women out here with PhDs and well-versed in everything that they need to know, and they’re still dying.
And I think what’s equally frustrating about these disparities is that some folks don’t believe them. And they’re like, “I don’t understand. They’re not. Oh no, that has to be a typo. Where’s the literature?” First of all.
Nacole (08:05): “It’s a misunderstanding. It’s a misunderstanding.”
Nikki (08:09): It’s a misunderstanding. Or they think this is something new. Like, “Oh my gosh, when did this start?” Black women been dying, actually.
Nacole (08:15): Yeah, been dying. Seriously. I’m sorry. It’s laughable because it’s so insane that no one’s heard of this until just now.
Nikki (08:22): Right. Exactly. I had to present in front of my city council one time, and they’re like, “These statistics are startling. When did this happen?” I’m like, “People in your district been dying. Why don’t you know these things?” And it is just so frustrating because we sit and have all these summits and conferences and webinars with sandwiches and we talk about it and we talk about it.
And I’m like, “I’m tired of meeting about this. When are we going to put knowledge to action? Because I’ve already told you, the statistics have told you, we’ve produced a number of reports statewide, nationally, internationally. And yet, what is it going to take for someone to put that knowledge to action and really start boots on the ground, providing services?”
Nacole (09:05): I’ve heard that Louisiana has, I guess it’s called a maternity care desert. Can you elaborate on exactly what that term means?
Nikki (09:12): So, that means that we don’t have services. Like we have spaces, we have pockets of Louisiana, primarily in central Louisiana where there’s very little obstetric care. So, you have to go to Northern Louisiana to get your obstetric care, or you have to come down to Southern and Southeast Louisiana, which is where New Orleans is.
And that kind of speaks to why our maternal mortality rate is so high, because Louisiana has one of the highest in the United States. And we have the second highest infant mortality rate in the United States.
It’s disheartening, because over 95 percent of Louisiana is deemed a federally designated health professional shortage area. That means we need providers. We need tons of providers, which is why literally yesterday, our bill to get rid of the collaborative practice agreement for nurse practitioners so we can allow us to work to our full scope — it got to Senate and it stalled in Senate yesterday.
And so we’re like, “Oh my gosh. Do y’all understand the health crisis here?” Be the change you want to be in the South, because nobody in the South has the nurse practitioners or an independent practice. But I’m like, Louisiana, of all states, let’s be first in something good.
Nacole (10:21): Yeah, seriously. For sure. Yeah. Please get this through. Your community is dying for providers. Please help us.
Nikki (10:28): Right. Literally, literally. And we have these areas where there’s no obstetric care. People have to drive an hour and a half to two hours to get to their visits. And I’m like, think about it. Okay, that’s the visit. Now, we have about how many visits? About 12, 13 prenatal visits. You’re in these areas. Now this is a rural area. Most of Louisiana, 80 percent of Louisiana, we’re rural. Okay?
So, think about wifi in rural spaces. Even during COVID, they couldn’t do telehealth. COVID kind of unveiled all these things like, “Oh my gosh, I’ve been treating everyone as if they had the same resources.” Well, you should have known that. You should have known everybody wasn’t equal. Duh.
Nacole (11:16): For sure.
Nikki (11:16): A, we’re in the south. B, we’re in Louisiana, and we have the highest maternal mortality rates. So, that’s essentially what our maternity care desert is. We just lack obstetric providers. Louisiana, we don’t have a whole lot of midwives. We have maybe 20 midwives, but we have more home birth midwives, and you can’t be a certified nurse midwife and do home births. You have to work in the hospital.
Nacole (11:40): Oh, I didn’t know that.
Nikki (11:41): Yeah. They allow lay professional midwives, licensed professional midwives, to do home births in the state of Louisiana. So it really is an interesting space of we have opportunity to make change, but sometimes we let politics and we’re literally politicking women’s bodies, and that’s unfortunate.
Nacole (12:01): Now, Nikki, can you tell me a little more about the patient population and your practice and the specific barriers to achieving good health in your community?
Nikki (12:09): Yeah. So my primary patient population is homeless, pregnant teens that are survivors of sex trafficking. So when you talk about — so let’s think about this broad amount of pregnant folks. Now let’s narrow it into homeless. Let’s narrow it into teens. Now let’s narrow it into black women and then survivors of sex trafficking. Talk about a pocket of folks that are truly under-resourced and marginalized.
That is the group of folks that I work with. And there’s a lot of trauma, lots and lots of trauma that are involved in their care. And we lack — some of our providers, obstetric providers, lack that knowledge of trauma informed care. So my patient population is really unique and has some needs that other populations may not have, but also they’re often overlooked or dismissed a lot.
Nacole (13:07): Now, Nikki, what brought you to that particular patient population? Or was it just something that you fell into?
Nikki (13:12): I think since nursing school, I’ve always loved adolescent medicine and the unique things that — adolescents, they are children, but they not. They’re in this weird space of, “I’m an adult,” but you’re not though. Not yet.
But growing up, we always did volunteer work with the homeless population in high school. I had a summer reading program at a homeless shelter for women and children. And during high school hours, I was a junior board member.
Coming back — graduated from my first bachelor’s degree in sociology. I worked there as a case manager. So I’ve always actually worked with the homeless population and it’s my comfort zone. When you blend my work with adolescent medicine, I worked at school-based health. And as a school nurse, put those two together, that actually felt really good and really comforting for me to work with homeless teens. And now you add in the pregnancy piece of where do they go?
That is the true essence of you’re kind of in this child’s space, but you’re pregnant and now you’re in this adult space. You’re meant to navigate a whole system that is kind of designed for adults, and they don’t actually know what questions to ask.
Some of them, they’re still seeing pediatricians. Some of my patients are still seeing pediatricians. So they have never had their first pelvic exam because they’re not 18. There was no need for a pelvic exam. So, it’s really this weird space. And I really like to help them. Not in a maternal way. I’m not their mama, nor am I trying to be.
And I want people to know that, because some people that come into the space, some of the providers that we’ve encountered, they’re like, “Oh, I’m your mama now.” And I’ve gone in a space. I’m like, “You are not her mother. She doesn’t need a mother — she doesn’t need you to be her mother.” And she was like, “Nurse Nikki’s your auntie.” No, no, no.
That’s not what we’re doing. We’re here to provide support, probably a support that you’ve not had before. It’s a new support and it can be scary for some. So some of my patients are like, “You too much nurse Nikki, you’re too much right now.” Because I’m giving them support that they’ve never had.
Nacole (15:13): Now, in terms of the non-traditional support that you’re speaking of, what do you offer?
Nikki (15:19): We, and when I say we, I have three amazing nurses that work with me and we have an operations manager. We give them the care they need when they need it the most. And 100 percent of our clients are on Medicaid. And so a lot of times — and you may be familiar with this. And a lot of nurses, Medicaid take a little time to get their services.
Nacole (15:44): Seriously, no joke.
Nikki (15:45): But then the folks that are usually on Medicaid are the ones in these marginalized under-resourced high-risk areas. So, I’m like, that actually doesn’t go together. So that’s what makes us unique is that we give them the care when they need it the most, period.
And we go to safe houses, we go to homeless shelters. We go to places that most people don’t want to go to. And we have our backpacks and we go in there and we give them care.
Like for example, during COVID, a mom, a parent, she was high risk during her pregnancy. She’s 19 years old, she was high risk. She had preeclampsia. She had postpartum hypertension. She was on mag when she left. She has a nine year old that was doing virtual school and she had this new baby, but she’s also what we call transient.
So she’s living in this hotel. Hotel is crawling with trafficking. So, they kept asking like, “Why won’t she come in for her postpartum visit?” First of all, the postpartum visit is trash. The way in which it’s designed, it is not helpful at all to anybody.
Nacole (16:46): Why do you say that?
Nikki (16:48): I think because they go in there and the agenda is at your six weeks, they give people this false hope of, “You’re fine. Everything should be fine.” And if you’re not fine, then something’s wrong, but they don’t know how to help you. And they can’t refer you.
And there’s no resources for that or they put some medicine on it, give you a little estrogen cream and put you on your way or that’s time to get birth control. And a lot of people see that as their — they call it the birth control visit.
Nacole (17:10): Oh yeah. I did get mine in my postpartum. Now that you brought it up — okay, got it. Got it.
Nikki (17:16): And you can come in with a complaint like, “Oh, it kind of hurts down there.” And they’re like, “Well, I mean, you look good. You can start running, doing CrossFit, whatever.” You’re still peeing on yourself. And they’re just like, “It’ll get better.”
Nacole (17:29): You were describing my exact visit. I remember being mad when I left. I remember being upset when I left, because the whole point was just birth control, telling me I’m fine and I can get back out there. And I was like, “Nah, bro, I don’t feel good though.”
Nikki (17:43): Right. Only 40 percent of women are going to their postpartum visit because they probably would think, “I’m waiting here for an hour and then being seen for 15 minutes, and I’m still peeing myself every time I cough and sneeze.”
So this mom, she was supposed to come in to get her postpartum check because also she was recovering from, or we thought recovering from, postpartum hypertension. Well, she didn’t come in because there’s a COVID protocol. You cannot bring any visitors with you. Remember, she has a nine year old and she has this newborn baby.
Now she’s like, “Even if I find somebody for my nine-year-old, can I bring my baby?” Because this is the reason why I’m coming for this postpartum visit, because of this baby. And they were like, “No, no, you can’t bring the baby as a visitor.” What the hell he going to do? Where does he go? He’s six weeks old. So, she didn’t go.
And so they’re like, “Nikki, can you go find her?” And so I’m kind of like the postpartum bounty hunter here going out and finding where these people are. And so we found her at a hotel and we went there and talked to her and she was very grateful.
We took her a month’s supply of diapers, which all of our clients get a month’s supply of diapers. They get a month’s supply of wipes. We get hygiene products. If you need a blood pressure cuff, if you need a breast pump, we’re here to give it to you because we do understand that it is a privilege to be able to go to Target and pick that stuff up. It is a privilege to even be able to travel to WIC, right? Because it’s an access issue.
You have to get in a car, you have to have that transportation. We went there, her incision was infected. Her blood pressure was 160 over 90. So we were able to contact her high-risk doctor and say, “This is what’s happening.” They called in the prescription and then it was delivered. So that was a win for us.
But obviously, it’s not always like that. We can’t always find the parent or the mom’s like, “I’ll get here.” “Your blood pressure is 210, ma’am, 210. No, you need to go to the ER right now.” She’s like, “I’m not leaving my kids.” And I’m like, “Okay, I understand that.”
So that’s what our unique care is, and folks are so appreciative, even though they’re like — sometimes our treatment plan is not within their — they’re like, “I’m not doing that.” I’m like, “Okay, what is the next safest thing for you to do?”
And so we have to adjust. And sometimes the providers back in the hospital, like, “She needs to come here. I can only provide care here.” No, we need to learn how to provide better community care. And that’s what our practice really challenges our healthcare system to do, is to provide better community care, because not everyone can access that tertiary care center or whatever. They can’t always come back to there. That cannot be the only safe space.
We have to learn how to provide care in the community and maybe in their homes, which is how it’s done in the rest of the world. I want to challenge my colleagues and the people that want to do this work or any nurses in general — ask the hard questions.
And I get it. Once we know, we can’t not know, but damn it’s the only way. It’s the only way to help under-resourced parents once we know what resources they need. And we can’t know if we don’t ask. And I think that’s a fear.
And I’ve talked to a lot of my colleagues, I’ll call them or something. They’re like, “Oh, I thought something was weird about their story.” And I’m like, “Did you ask?” And they’re like, “No, because I didn’t know what to do once I did ask.” If you got through four years of medical school and residency, I’m sure we could figure this out.
Nacole (21:07): Now, what do you consider to be a hard question?
Nikki (21:10): So just asking, first of all, the drug questions. A lot of times we don’t want to ask the drug questions. Some people actually feel more comfortable asking the drug questions than the abuse questions, because I think the abuse question — “Do you feel safe?” That is the question people ask. “Do you feel safe?” And people are like, “Yes.”
But you have to understand that some people think differently. They could be thinking that literally like in this very moment. Yes, I feel safe in this room with you.
Nacole (21:33): Oh. And not at their house. Oh, I see what you mean. Okay. Okay.
Nikki (21:38): And I’m like, did you say, “Do you feel safe in your home?” And then some people say, “Yes, I feel safe.” Even if you take it a step further and say, “Do you feel safe in your home?” they’re like, “Yes. I feel safe in my home.” But what neighborhood do they live in? Do they feel safe walking outside of their home?
Nacole (21:50): Oh, that’s a good one.
Nikki (21:51): And do they feel safe with the people that are living that could frequent their home? It’s so many more questions that we could ask that we don’t ask. And that’s why a lot of times they say providers miss trafficking. They miss it because they don’t ask some of the questions, and people are like, “I just don’t know what happened.” Or as a teenager, are they having sex? You ask a 15 year old if they’re having sex. And you’re like, “I don’t know what to do with that answer.”
Nacole (22:17): Once you get the answer, what are you going to do with the information?
Nikki (22:18): Yeah.
Nacole (22:19): Okay. I see.
Nikki (22:20): Yeah. They don’t know how to ask the hard question. They may be afraid of the answer that they get. And I think we just have to take it and treat everyone with individualized care. That’s our gold standard, right? It’s not another medical record number. It’s individualized care.
And we shouldn’t just go down our checklist and you ask the question not even looking at them without the eye contact and things like that. Really trying to help them. I know we have a certain amount of time, right. Provider’s like, “Well, I only have 15 minutes.” Make that 15 minutes count. Make it change their life, make it change their healthcare. That’s our job.
Nacole (22:54): I had a situation like that too. I mentioned the safety thing, but you’re so used to hearing the same answer. “Oh, I feel safe.” And I expected them to say that. So I just kept talking, and she was like, “You can’t send me home.” And I was like, “Oh, why? You don’t have transportation? Let me get a social worker.” She was like, “No, I can’t go home. He’s going to hurt me if I go home.”
And then I was like, I did not even think about if, when I was discharging her, if she was safe to go. I felt really bad that I just assumed that her life was going to be fine when she got home and her only hurdle was medical. She didn’t have any psychological things going on. She didn’t need anything else.
And then I was like, “Oh, well let me call a social worker.” And it was like, once you have that information, you acted upon it. But you realize that if you don’t initiate it, sometimes you don’t get the information.
Nikki (23:42): Right. Right. Sometimes you have to take it a step further. I know that with myself, I’ve started asking a little bit more. So, a patient, I’ll say, “Well, how are you feeling today?” “I’m okay.” I don’t stop at okay. I don’t actually like the word okay. I say, “What would make you better than okay?”
And then I’m digging deeper, but not super invasive. Just one thing that would make you better than okay. “Well, I would really like for my vagina not to be dry.” And I’m like, “Okay. Let’s talk about that.” Let’s talk about vaginal dryness. Bringing them out so they can talk about things, because they may not even know how to articulate it or may be scared to talk about it.
I’m so nosy. I’m all up in your business. I’m all up in the business. I could meet a random person. They’re like, “Oh yeah, my limp.” I’m like, “Oh girl, how do you get that limp? What happened? Why is it doing that?”
Nacole (24:36): I’d love for you to take care of me. I have so many unresolved medical issues. And I’m like, “No, it’ll go away. It’s fine. I’m not going to worry about it. Nah, it’s fine. I’m not going to worry about it.”
Nikki (24:44): Have you tried this at all?
Nacole (24:48): Now Nikki, how has your practice evolved over time? Now, I know you mentioned all the resources you provide, but has anything evolved or changed?
Nikki (24:55): I think my patient care is continuous in that it’s what the client needs in that moment. But I also know that my care plans have evolved a little bit more. And I have to think more in terms of what COVID prevents people from doing or as far as jobs and things like that, or a mom who I was like — the homeless shelter called me, and they’re like, “This mom really needs help.” I’m like, “I’m there, I’m all over it.”
And I was like, “Let’s make a visit, make a visit.” And I couldn’t get in contact with her. She just would not sit down and she’s like, “I’m trying to work, Nurse Nikki.” And you really have to — “It’s COVID, all these things. I really have to provide for my baby. I don’t want to be in this homeless shelter.”
So I really have to pause a lot more and just kind of be more creative in ways in which I interact with people or Zoom is not working for everybody. I’m like, “Let’s try something else.” So I’ve actually become more virtual because COVID has kind of displaced a lot of folks. And I feel like there’s a lot of moving parts and people are trying to figure out how to get themselves back into the rhythm of things.
So I’ve become more virtual with my clients and they actually like that. And I think being able to capture more of my visits in a more systemic way. Because they’re so unorthodox, being able to capture so we can get grant funding. Because one thing I will not do, I will not tap into this person’s Medicaid. I will not take any insurance from them because I know that takes a visit or time away from another provider that they can be accessing.
Nacole (26:24): Oh, so you’re not going through their insurance? I was going to ask about that.
Nikki (26:26): I do not. No, I do not go through their insurance at all.
Nacole (26:29): Okay. Wow.
Nikki (26:30): One of the things is that with Medicaid, you have Medicaid throughout your entire pregnancy and three months postpartum for a lot of folks. And then it just shuts off.
Here’s the thing. I cannot actually take care of you while you’re within that pregnancy bundle, because I did not deliver your baby. So I can only take care of you after three months — your six weeks, rather. Your six week check. And their Medicaid was like, “Oh, they don’t have insurance anymore.” And I’m like, “Okay, well, how am I supposed to get paid?”
So I actually go through the organizations that provide social services for pregnant folks, pregnant teens. So we have homeless shelters, we have Healthy Start. We have Head Start. All of those programs. They contact me and I contract with them so there’s no charge to any of my patients.
Nacole (27:14): Oh, I didn’t know that.
Nikki (27:16): Nope. My patients don’t have to pay a dime. Nothing.
Nacole (27:18): Wow. That’s amazing.
Nikki (27:20): And I also get grant funding through various organizations where I use this data from working with the patients and the social service organizations. I write grants and we’ve been able to get some grant funding to help even with the bundles that we make. We — like I said, diapers, wipes, blood pressure cuffs, breast pumps.
We have pop-up bassinets, things like that, because they’re transient. Something they can easily take around with them. We promote safe sleep in every environment. So different things like that. We like thinking outside of the box. And I like to think of myself as the medical muscle for all of the social —
Nacole (27:53): MacGyver? Medical MacGyver.
Nikki (27:56): Right. For all the social service organizations that we partner with, I’m that liaison that leads them there so they can get equitable care, get the care that they need.
Nacole (28:05): Now, Nikki, I don’t know if you know this, but I follow you on Instagram. And your Instagram is hilarious. I even learn things myself. Can you talk about how you’ve developed that kind of side of social media and education in your approach?
Nikki (28:19): Yeah. So I don’t actually like social media a whole lot.
Nacole (28:22): You’re like, thank you. But I don’t like it.
Nikki (28:26): Once you’re in it, it’s like jumping into a pool and you don’t want to get out because you’ll get cold. So you just stay in the pool. But one thing I realized in that talking to my family — because my family, even though they think I’m weird because I talk about all these weird things, they’ll text me like, “Hey Nikki. So I have a question.” Folks don’t know what they don’t know.
Nacole (28:46): So true.
Nikki (28:47): That’s why a box of diapers has directions on it. Because not everybody know how to put on a diaper. And that’s why some people will look at those directions. So we make a lot of assumptions, a lot of assumptions about people’s knowledge and foundation knowledge. And we realize there are different foundations. Right?
Nacole (29:05): Very true.
Nikki (29:05): But when I have grown adults telling me in my DMs saying their pee comes out the same hole as their poop, then Houston, we have a problem. We have a big old problem.
Nacole (29:16): No. Really?
Nikki (29:17): Yes. Argue me up and down. “Nurse Nikki, my pee actually comes out of the same hole as my poop.” And I was like, “Lies. Nope, it doesn’t. Unless you have a huge fistula, it does not.”
Nacole (29:27): Huge, huge, fistula. Track tracking fistula. That is not true.
Nikki (29:31): It’s not true.
Nacole (29:32): So at least they’re getting educated. So your account is not just humor. I see you posting educational things too. So the audience does then respond to the education that you’re giving them. Beautiful.
Nikki (29:43): Right. Right. So I have my Vira, the vagina.
Nacole (29:47): I saw that.
Nikki (29:48): And we have a new one. Her name is Poppy.
Nacole (29:51): Spill the Tea Tuesday. I saw that one.
Nikki (29:53): Spill the Tea Tuesday, where we’re just trying to drop some gems. But I absolutely love talking about taboo things. And I think people do find them embarrassing. Some people they’re like, “Why are you talking about this?”
Because you actually want to talk about it. And this is your feelings, right? And they’re only embarrassing because we feel like no one else has a fishy vagina. No one else has leaky bladders. But they do.
Nacole (30:16): Correct. They do. Lots of people.
Nikki (30:17): Lots and lots of people. I can smell it from a mile away. That’s how sensitive my nose is.
Nacole (30:23): Yeah, we’re all women. But like you said, they will not talk about it. It’ll just be something. And then you’ll mention it, and they’re like, “Oh, I thought it always was like that.”
Nikki (30:34): Right. Like this past weekend I actually was working a private consultation that I was doing. And there was this group of officers, and it was a captain and it was four sergeants or something. And we start talking and she said something about a yeast infection.
I’m like, “Oh, tell me more about this yeast infection.” She’s like, “Really? Right now?” I’m like, “Yes, I would like to know.” And so we were talking about it and I’m like, “Did you get the MONISTAT one day?” And she’s like, “No, no, I got the three day.” I’m like, “Yeah, because MONISTAT one day, it burns.” And I’m like, “Oh, you really should use this.” And everybody’s listening. And I’m like, “And you should really go pee.” And they were like, “Thank you so much for that knowledge.” And that took like five minutes.
Nacole (31:08): Yeah. Because as a female, if you don’t have another female around you — and it’s not like you’re going to mention these topics to your husband or your partner. They’re very private.
Nikki (31:21): I do. We got to talk to somebody about it. I get so many questions, text messages. Or I get the thing of, “Nurse Nikki, can I send you a picture?” I’m like, “What is it a picture of first?”
Nacole (31:31): Yeah. Hold on. Wait. Let me move away from my five year old.
Nacole (31:35): Yeah. Hold on. Let me get ready here.
Nikki (31:39): So I love it.
Nacole (31:40): Now, I know you’re a strong believer in continuing education. What are really some of your kind of go-to resources that you recommend other nurses check out?
Nikki (31:48): So I think for all nurses, A, one, it’s about obstetric nursing and things like that. I think it’s a really great resource. They’re really adding more and more resources about maternal care and how to provide equitable maternal care, but just equitable care in general — black mamas matter, national birth equity, collaborative reaching our sisters everywhere about breastfeeding, things like that.
Nurse practitioners in women’s health, they have a great organization, but you don’t even have to be a women’s health nurse practitioner. You can be family. And I think it’s great for family nurse practitioners, because we do see vagina owners in our practice that we should go in with an equity lens.
We should go in with the LGBTQ lens of when we talk to our patients, understanding and respecting their pronouns, what their needs are and being able to provide that individualized care as opposed to trying to lump everybody together.
And you have a vagina, therefore you get this type of care. You have a penis, you get this type of care and that’s not actually how care works. That’s actually how it works now. But that’s how it shouldn’t work.
ACOG is really trying to do better, American Academy of Pediatrics. So I want to challenge nurses to go within the organizations where you’re accredited or your interest area and find that stuff. And if you have to dig too much then you may need to call somebody and say, “Hey, what are you doing about this? How are we providing better care, more equitable care, individualized care, community care, bridging that gap between hospital and community care?” And challenge them to be better, to do better.
Nacole (33:19): Now, I want to piggyback on the resources and ask you, what advice would you give to nurses who are just starting out who might not know where to start when it comes to health equity, or just addressing social determinants in general?
Nikki (33:31): I think your experience is whatever you make it. Your career can be whatever you make it, as Nacole and I, as you and I have both created these unique careers. It is what you make it. So you first have to understand your bias. Everyone has to check themselves. You cannot be uncheckable.
And if you go into your space, if that’s the type of care that you provide, where you can’t be checked, then I don’t know if you should be providing care. You have to be able to go inside and see your privileges, your bias. Because even I come to spaces with bias. You have to check that and then go and say, “How can I be better?”
And go find those resources to improve and to keep educating yourself about whatever your niche is or just things like, “You know what? I’ve been seeing this. This has been a hot topic lately, like maternal mortality, especially among black and brown women. Let me dive into this and let me learn more,” because what you don’t want to do is be in a conversation with folks and they start spewing stuff. You want to be able to say, “Actually, that’s not right.” Or “I’ve heard that,” or you don’t want to go in there and just be spewing lies.
Nacole (34:36): And not have proper education and knowledge. That’s for sure.
Nikki (34:39): Thank you. We see that all the time.
Nacole (34:40): Now, what challenges have you faced in terms of providing care for people in the community? I know that you don’t use their insurance, but as far as your grants and your funding, what barriers do you face regarding providing care as a nurse practitioner?
Nikki (34:53): Sometimes it’s the politics of it all. And I really hate that we politic women’s health and reproductive health, but it really is the politics of it. They’re like, “Oh, well that’s not really a priority right now.” And I get that. I hear that a lot. “Oh, that’s not really our focus,” or “That’s not a priority right now.”
Where, for example, I don’t work directly with hospitals per se, but I have providers inside of some hospitals. They’ll call me on the low and be like, “Nurse Nikki, I need you to see this patient,” or, “I need you to check on this patient. Can you go to this patient’s house?” And they know that I’m not going to get paid for it.
Or I’m like, “Oh, I’ll cover it under our grant,” or they’ll come and they’re like, “Nurse Nikki, I really wish you worked at our hospital. I really wish that you could be in this space.” And I was like, “I don’t think I would do well.”
Nacole (35:41): Really? Why do you say that?
Nikki (35:43): I don’t think because I push too many buttons. I’m like, “Ahhhh!”
Nacole (35:44): Oh, okay.
Nikki (35:45): I think it’s so many policies and so many old schools of thought that are going on.
Nacole (35:52): They’re not ready for you.
Nikki (35:53): They’re just not ready. They’re not ready for the revolution. And it will not be televised.
Nacole (35:56): They’re not ready. They’re not ready for this transition. This fire, this heat.
Nikki (36:03): Thank you. They’re not ready for this heat because I’m loud and pull like a house. I see myself.
Nacole (36:07): But you get it done though. I mean, look what you’re doing. I thought this whole time you were processing all of this through their insurance.
Nikki (36:13): No ma’am.
Nacole (36:13): And you’re telling me you’re not touching their insurance. And you’re providing all these resources. That’s amazing. I have so many patients that are like, “I would love to see you. I would love to do this. I don’t have insurance.” And like you said, I work in the inpatient. So after I hear that, I don’t know what to do with you. I seriously do not.
Nikki (36:31): Exactly. And that’s why I wish we had more. And here’s the thing. We have folks in the community doing the work. I have so many colleagues all over the United States that are doing this work. It’s just a matter of these are grassroots organizations and they don’t get the same respect as some of these large nonprofits.
They’re like, “Oh, I don’t have a nonprofit. I don’t have that, but I know I’m doing the work.” And they’re working literally with passion and pennies. That’s what we’re working with, passion and pennies, to get this work done because we know. We’ve heard the stories. We’ve been there with the parent where they’ve lost a baby or they’ve lost a mom to this maternal mortality, these disparities. And we’re just like, “I can’t do this anymore. I have to be the change I want to see.”
Nacole (37:17): Well, Nikki, thank you so much for letting us interview you on SHIFT Talk. I learned so much. This is your second time around. And again, I have a page full of notes I learned. So every time you come on, I learn so much.
Nikki (37:32): Oh, thank you. And good luck to you on this baby.
Nacole (37:35): Thank you. I’ll be hitting you with a couple of DMs in a minute here.
Nikki (37:38): No problem.
Nacole (37:40): Just keep your box open. Keep your box open.
Nikki (37:41): I love it. I love it. I’m ready.
Nacole (37:44): Take care, you stay safe.
Nikki (37:45): All right. Thank you. Same to you.
Nacole (37:52): Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers.
SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guests and hosts only and do not reflect the views of the Robert Wood Johnson Foundation.
To learn more about our guests and hear more nurses talk about the important issues they’re facing right now, visit our website, shiftnursing.com. And please, please, guys, you have to subscribe, rate and review SHIFT Talk wherever you get your content from. Until next time, stay safe and keep being awesome.